Prognostic value of high sensitive C-reactive protein in subjects with silent myocardial ischemia

Objectives: The aim of this study was to evaluate the prognostic value of high sensitive C-reactive protein (CRP) in subjects with silent myocardial ischemia (SMI). Design: In total, 678 healthy men and women aged 55 to 75 years with no history of cardiovascular disease or stroke were included. High-sensitive CRP and 48-hour ambulatory ECG monitoring were performed. The primary endpoint was the combined endpoint of death and myocardial infarction. Results: The median follow-up time was 76 months. Seventy-seven subjects (11.4%) had SMI. The combined endpoint occurred in 26% of the subjects with SMI and 14% of the subjects without SMI (P = .005). SMI had a poor prognosis in the group with an elevated CRP mu g/mL (hazard ratio, 3.46; 95% confidence interval, 1.67-7.16; P = .001) compared with the group of subjects with SMI and a low CRP <3.0 mu g/mL (hazard ratio, 1.37; 95% confidence interval, 0.63-2.98; P = .54). Conclusions: In apparently healthy subjects, a low level of CRP <3.0 mu g/mL selects a low-risk subgroup, despite the presence of SMI. (c) 2012 Elsevier Inc. All rights reserved.